47 Impact of systematic pelvic and para-aortic lymphadenectomy after six cycles of neoadjuvant chemotherapy in high-grade serous ovarian carcinoma. (18th September 2019) - Lopes, A
Abstract : Objectives: Analyze the role of systematic pelvic and para-aortic lymphadenectomy after 6 cycles of neoadjuvant chemotherapy (NACHT) in advanced high-grade serous ovarian carcinoma. Methods: From 2008 to 2016, patients with epithelial ovarian carcinoma who underwent NACHT (carboplatin-paclitaxel) were reviewed. High-grade serous histology, FIGO stage IIIC-IVB, complete or optimal cytoreduction and absence of enlarged lymph nodes after NACHT were the inclusion criteria. Patients who underwent systematic pelvic and aortic lymphadenectomy were compared to those who did not undergo any lymph node dissection. Patients with partial lymphadenectomy or with bulky lymph nodes were excluded. Progression-free survival and overall survival were analyzed using Cox-proportional hazard. Results: From a total of 132 patients surgically treated after NACHT, 62 met the study criteria. Forty patients underwent lymphadenectomy and 22 did not (control group). Among all patients included in the study, 38% (N=24) had suspicious lymph nodes at initial diagnosis, of these, 11 in the no-lymphadenectomy group. Patients' characteristics, blood transfusion and complications were equivalent. Twelve patients (28%) had histologically positive lymph nodes. Surgical time was higher in the lymphadenectomy group, 229 vs 164 minutes (P= <0.0001). Median overall survival: 55.6 (95% CI 45.9–65.3) and 61.2 (32.2–90.2) months (P=0.8) and progression-free survival: 8.1(95% CI 5.8–10.4) and 8.3 (4.8–11.7) (P=0.9) were similar in the lymphadenectomy and control groups respectively. Exclusive lymph node recurrence occurred in 3 patients of the lymphadenectomy group and 1 from the control group. Conclusions: Systematic lymphadenectomy after 6 cycles of NACHT may not impact survival of advanced high-grade serous ovarian carcinoma.